A new article in the academic journal Psychosomatics:

Castration for Hire: Genital Self-Mutilation Performed by Third Party at Patient Request

SalilPhadnisBS1 (https://www.sciencedirect.com/science/a ... 8220302619#!)AlexisCohen-OramMD2 (https://www.sciencedirect.com/science/a ... 8220302619#!)PatrickMacIverMD2 (https://www.sciencedirect.com/science/a ... 8220302619#!)

1 University of South Florida Morsani College of Medicine

2 Department of Psychiatry, University of South Florida Morsani College of Medicine

Psychosomatics (https://www.sciencedirect.com/science/journal/00333182)

Available online 3 October 2020

In Press, Journal Pre-proof (https://www.sciencedirect.com/science/j ... p/00333182)

https://doi.org/10.1016/j.psym.2020.09.012 (https://doi.org/10.1016/j.psym.2020.09.012)

Abstract

Male genital self mutilation (GSM) has traditionally been thought to take place primarily in the setting of acute psychosis, however, recent research has suggested a greater prevalence of non-psychotic patients performing GSM for reasons such as reduction of libido, body dysmorphia, and fantasy. We present a unique case in which a 52 year old male seeking castration met an individual in an online chat room for eunuchs and arranged for him to perform the procedure, resulting in his hospitalization. He closely matches a demographic of individuals previously surveyed in the Eunuch Archives forum and exemplifies the significant risks they face when attempting genital self-mutilation. Their medical histories suggest a significant period of time prior to a GSM attempt during which medical professionals may be able to intervene and provide appropriate care.

ARTICLE

Male genital self-mutilation (GSM) and voluntary castration is a rare phenomenon, and many individuals who perform it never come to the attention of the medical system. As a result, understanding the frequency, motivations, and risk factors associated with GSM has proven to be quite difficult. Early evidence showed that the majority of GSM cases (up to 87%) occurred in the setting of acute psychosis 1 (https://www.sciencedirect.com/science/a ... 02619#bib1), 2 (https://www.sciencedirect.com/science/a ... 02619#bib2), 3 (https://www.sciencedirect.com/science/a ... 02619#bib3). More recently, reports have suggested a greater prevalence of non-psychotic patients performing GSM with diverse motivations including reduction of libido, body dysmorphia, and fantasy 4 (https://www.sciencedirect.com/science/a ... 02619#bib4),5 (https://www.sciencedirect.com/science/a ... 02619#bib5). These individuals have been colloquially referred to as “eunuchs” or “eunuch-wannabes”. A review of existing case studies showed a pattern of men acting alone, discreetly, and spontaneously. However, the internet has provided individuals with an anonymous, widely accessible platform to share their experiences, leading to the creation of various chat rooms and forums dedicated to self-castration 4 (https://www.sciencedirect.com/science/a ... 02619#bib4). This has also provided researchers with an opportunity to further study these groups through online surveys and interviews. We present a unique case in which a man seeking castration met an individual in one such chat room and arranged for him perform the procedure. It supports recent survey data regarding the demographics and histories of individuals at risk of performing self-castration, and demonstrates the complications that can result from the sharing of these topics without appropriate medical guidance.

A 52-year old Caucasian male with past psychiatric history of alcohol abuse disorder and unspecified depression was admitted to hospital after voluntarily undergoing removal of his testicles by a man (hereafter referred to as the perpetrator) he had met online in a chat room for eunuchs. On initial assessment by emergency room staff, he was fully alert and oriented to his surroundings. Physical exam was significant for two large, open incisions on his scrotum. He had an appropriate affect, with mood congruent to thought content. He was fully cooperative with police, EMS, and emergency department physicians and staff. Due to concerns that patient was a risk of further harm to himself without psychiatric treatment, he was placed under an involuntary mental health hold by the emergency department physician.

Psychiatry was consulted due to the self-inflicted nature of his injuries as well as suicidal ideation voiced during his initial rescue and transport to hospital. We first interviewed the patient while he was recovering after emergent surgical intervention, and afterwards daily until discharge. He reported that this episode of self-mutilation was tied to a longstanding struggle with depression and his own sexuality. He was openly gay from early adulthood, and while his family was supportive of him, his romantic relationships were tumultuous. According to our patient, his romantic history was the most significant contributor to his mood, with the ends of relationships often triggering long periods of severe depression, anxiety, and alcohol abuse. Eventually, he came to believe that suppressing his sexual drive would diminish his need for a romantic relationship, ideally preventing the possibility of difficult separations and further lapses into depression. With this goal in mind, he began exploring various chat rooms and forums dedicated to genital castration. By the time of his hospitalization, he had been exploring the subject for at least twenty years. He reported believing that in some ways he “deserved it”, though he denied feeling guilty about any particular event or action. He firmly denied that the castration was a suicide attempt. The patient reported he found the perpetrator online and was aware that he was not a medical professional. The pair had spoken frequently in the previous year and discussed the issue repeatedly. The patient proceeded with the castration during a period of depression and intoxication following the end of his latest relationship one month earlier.

The patient had attempted treatment with medical therapy including SSRIs and SNRIs, as well as psychotherapy many times in the past with limited success. Our service began a course of mirtazapine for depression and insomnia. On his second day of hospitalization, the patient reported little to no regret about his actions the previous day, and expressed only surprise that the procedure had been so bloody and traumatic. He was offered surgical options for reattaching his testicles but declined. His primary concerns were feeding his pets at home and obtaining a set of his own clothes to wear. These issues caused him significant, increasing anxiety during his stay in hospital. Ultimately, he was amenable to treating it with hydroxyzine as needed while awaiting assistance from social workers in locating a set of clothing and taking care of his pets. After his wounds had healed appropriately, he was transferred to a local psychiatric facility involuntarily for re-evaluation and further treatment. Unfortunately, he was lost to follow-up and did not return several phone calls to establish care.

There is a paucity of data regarding individuals who voluntarily pursue castration. Most available data stems from a 2008 survey conducted by researchers at Dalhousie University and the University of British Columbia on the Eunuch Archives, the largest known forum for eunuchs and “eunuch-wannabes”6 (https://www.sciencedirect.com/science/a ... 02619#bib6). Several striking similarities between our patient and the survey population are immediately apparent. Voluntary surgically castrated respondents had an average age of 46.1 6. Many had spent several years researching the subject and participating in eunuch interest groups prior to their castration. Forty nine percent of 92 voluntary surgically castrated respondents surveyed by Brett et al had a history of depression. Like our patient, at least 52% were primarily motivated by a “sense of control over sexual urges and/or sexual calm”, also referred to as a feeling of “eunuch calm” 7 (https://www.sciencedirect.com/science/a ... 02619#bib7).

Online chat rooms and forums are well-established, increasingly popular mediums for like-minded individuals to discuss uncomfortable medical and psychosocial issues. In interviews, many of these individuals cited embarrassment about seeking an orchiectomy, and harsh rejections by the physicians they approached as the primary reasons for turning to home remedies and perpetrators they met online 4 (https://www.sciencedirect.com/science/a ... 02619#bib4). Ultimately, 53% of them resorted to non-professional methods such as injections with caustic chemicals and home operations 7 (https://www.sciencedirect.com/science/a ... 02619#bib7). Our patient is a unique exemplar of the significant risks these particular individuals face when they proceed down that path, as well as a reminder that self-orchiectomy is not a transient phenomenon or one limited to the setting of psychosis. We may benefit from a reappraisal of how the medical community should approach patients with radical medical desires, as well as renewed effort to increase the availability of medical providers and services online.

References

1 (https://www.sciencedirect.com/science/a ... 2619#bbib1) H. Greilsheimer, J.E. Groves. Male genital self-mutilation

Arch Gen Psychiatry, 36 (4) (1979), pp. 441-446

2 (https://www.sciencedirect.com/science/a ... 2619#bbib2) S. Aboseif, R. Gomez, J.W. McAninch. Genital self-mutilation

J Urol, 150 (4) (1993), pp. 1143-1146

3 (https://www.sciencedirect.com/science/a ... 2619#bbib3) C.S. Romilly, M.T. Isaac. Male genital self-mutilation

Br J Hosp Med, 55 (7) (1996), pp. 427-431

4 (https://www.sciencedirect.com/science/a ... 2619#bbib4) T.W. Johnson, M.S. Irwig. The hidden world of self-castration and testicular self-injury

Nat Rev Urol, 11 (5) (2014), pp. 297-300

5 (https://www.sciencedirect.com/science/a ... 2619#bbib5) G. Catalano, M.C. Catalano, K.M. Carroll. Repetitive male genital self-mutilation: a case report and discussion of possible risk factors

J Sex Marital Ther, 28 (1) (2002), pp. 27-37

6 (https://www.sciencedirect.com/science/a ... 2619#bbib6) L.F. Roberts, M.A. Brett, T.W. Johnson, R.J. Wassersug. A passion for castration: characterizing men who are fascinated with castration, but have not been castrated

J Sex Med, 5 (7) (2008), pp. 1669-1680

7 (https://www.sciencedirect.com/science/a ... 2619#bbib7) M.A. Brett, L.F. Roberts, T.W. Johnson, R.J. Wassersug. Eunuchs in contemporary society: expectations, consequences, and adjustments to castration (part II)

J Sex Med, 4 (4 Pt 1) (2007), pp. 946-955

https://www.sciencedirect.com/science/a ... 8220302619# (https://www.sciencedirect.com/science/a ... 8220302619)!

What a wonderful article that didn't actually understand what is happening. If this is how medical people see us, we're doomed. All I see is a professional version of, "Hey! Look at the freaks!"

First thing, I'll get out of the way, people shouldn't use cutters. Period. And yes, I'm aware I did this back in 2005 for my testicles, but newsflash, services are more readily available from legitimate routes than they were 15 years ago.

Now onto the critique.

1. The first thing they did after he presented was put him on an involuntary psych hold, want to know why folks don't seek the help of legitimate practitioners? This is why. They're afraid this is what will happen to them, so by doing what they did, they just proved those folks right, and pushed many into the shadows when they were starting to poke their heads into the sun to find legitimate help.

2. That Emergency Department Physician put their own sexuality and belief system ahead of that of the patient. Put another way, they felt that since they would feel this is a fate worse than death, then obviously the patient is completely unstable and needs to be locked away for their own good until they understand that. Sorry, wrong answer.

3. The "suicidal ideation" was probably more due to the case hitting the headlines (as it did just that). The fear of that combined with the embarrassment he was about to undergo from essentially being outed in the press. Hmm... Might make one a bit irritable.

4. Clearly he is a danger to the community, after all, he was concerned about not being left naked (he wanted his own clothes), and that the animals in his care were properly cared for. Yes, clearly he's psychotic! Lock him away and let the innocent animals starve to death, start decomposing in the home, and then send your patient with wound issues in later to clean up the rotting carcasses. That will work wonders for infection control. The only psychotic thing in this instance was assuming the patient was psychotic for actually giving a f*** about other living creatures.

5. Yes, I've had lapses into depression after a break-up. I'm sure most people do. He was tired of lather, rinse, repeat, nature of his relationships, and felt ending his libido would stop that. Guess, what, I've been down that road too. Doesn't mean I would need to have been locked up involuntarily.

6. "Several striking similarities" between their patient and the EA surveys? DUH! The patient took part in those surveys. Yes, I know who he is. No I won't say who, that's up to him if he so chooses.

The people who wrote that article need to be locked up in a room and forced to read the DSM-V along with standards of care for individuals such as us. All these folks left me wanting to do is find a shovel to hit them upside the head with. They call themselves doctors... they're bigger hacks than the cutter was.

Reading an article like this, makes me think unless I want my life left in tatters, I need to suppress all these thoughts. Better to live with the terrible feelings of being so uncomfortable in my self identity. Very disappointing.

Losethem (imported) wrote: Tue Oct 06, 2020 12:44 pm What a wonderful article that didn't actually understand what is happening. If this is how medical people see us, we're doomed. All I see is a professional version of, "Hey! Look at the freaks!"

I see it slightly differently. Given the first author doesn't actually has an MD, I suspect it is a case of "I'm near the end of medical school and I need to publish something for the degree, so write any cr*p fast in any sh*tty journal that will accept it" mentality. I'm surprised a sample size of 1 actually get approved for publication as "research" in a journal that has been around for apparently 60 years.

Just curious, How is it Self-Mutilation if it was performed by third party?

If I go to the dentist to have a tooth pulled, is that self-extraction?

littleeunuch (imported) wrote: Fri Jan 22, 2021 1:28 am I see it slightly differently. Given the first author doesn't actually has an MD, I suspect it is a case of "I'm near the end of medical school and I need to publish something for the degree, so write any cr*p fast in any sh*tty journal that will accept it" mentality. I'm surprised a sample size of 1 actually get approved for publication as "research" in a journal that has been around for apparently 60 years.

The first author has a BS (Bachelor of Science), which could be on the medical school track, but isn't an indicator of medical school graduation, since in the US medical school is a graduate program. I would imagine if your thought is correct, if written by the student, this piece would more likely be some sort of supporting project for an undergraduate degree.

Whatever the case, two MD's did allow their names to be used, and signed onto it. Those two individuals should have known better than to attach their names to a hatchet piece like this without thinking on it critically. Clearly they don't care that much about what they attach their names to, which is a shame, because that could tarnish their reputation if they are young medical doctors.